Short-term efficacy analysis of transfemoral transcatheter aortic valve replacement and traditional surgical aortic valve replacement in patients with incomplete aortic valve closure alone

WANG Hua-jun; ZHANG Hang; SU Tong; LIAO Hong-juan; CHEN Zi-ying; SHI Feng-wu; MA Qian-li; LIU Su; AN Jing-hui

doi:10.3969/j.issn.1672-5301.2024.08.013

Abstract：Objective To compare and analyze the short-term clinical effect of transcatheter femoral aortic valve replacement and surgical aortic valve replacement in patients with simple aortic insufficiency.Methods The clinical data of 102 patients over 55 years old with simple aortic insufficiency(PAR)who were treated in the Department of Cardiac Great Vascular Surgery,Second Hospital of Hebei Medical University from May 2022 to September 2023 were retrospectively analyzed.Among them,46 patients underwent femoral transcatheter aortic valve replacement(TF-TAVR),and the other 56 underwent surgical aortic valve replacement(SAVR).The preoperative and postoperative data of the two groups were compared,and the results of 1 month follow-up period echocardiography were recorded.Results Compared with the SAVR group,the TF-TAVR group had higher mean age(P＜0.05),higher STS score(P＜0.001)and lower left ventricular ejection fraction(LVEF)(P＜0.001).There were no significant differences in gender,body mass index(BMI),preoperative cardiac function grade,left ventricular end-diastolic diameter(LVEDD),left atrial end-diastolic diameter(LAEDD)and preoperative underlying diseases between the two groups(P＞0.05).The postoperative cardiac function was significantly improved in both groups;the LVEF was higher than that before the surgery;the LVEDD was lower than that before surgery;and the LAEDD had no significant difference.There were no significant differences in postoperative improvement of cardiac function and LVEDD between the two groups.The time of ventilator-assisted breathing,postoperative ICU monitoring and postoperative hospitalization in the TF-TAVR group were significantly shorter than those in the SAVR group[(11.06±4.25)h vs.(20.25±8.17)h,(1.67±0.98)d vs.(2.92±1.08)d,(6.07±2.26)d vs.(9.90±2.16)d,P＜0.001].The incidence of arrhythmia in the TF-TAVR group was higher than that in the SAVR group.There was no significant difference in the incidence of postoperative pulmonary infection,severe pneumonia and pleural effusion between the two groups;and no stroke occurred both in the two groups.Although the incidence of mild and moderate perivalvular leakage/in-valvular leakage in the TF-TAVR group was higher than that in the SAVR group,moderate or above perivalvular leakage/in-valvular leakage did not occur in the TF-TAVR group.There was no postoperative death in the TF-TAVR group and there were 2 deaths in the SAVR group,but there was no significant difference in postoperative mortality between the two groups.Conclusion The early efficacy and safety of TF-TAVR and SAVR are similar in the treatment of PAR patients ≥55 years old,but the postoperative ventilator assisted breathing time,postoperative ICU monitoring time and postoperative hospitalization time after TF-TAVR are significantly shorter.